RWPS #14 - Denied Claims

BB2C-14 Problem Scenario: Denied Claims

Problem Description

The number of denied claims (bills submitted to insurance companies that they are refusing to pay) has increased. There are a limited number of days that the bill can be resubmitted for payment. The bill must be reviewed and the reason for denial investigated and corrections made if there was a billing error. At the same time, there is a backlog of new bills that need to go out that were delayed because of a computer conversion. The same staff does both jobs and they are struggling with how to get both portions of the work done in a timely manner to ensure reimbursement.